Practical Pearls on Glaucoma

Dr. Sunil Gupta, MS (OPH), FAGE

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Never diagnose Glaucoma on the basis of a single high reading of Intraocular Pressure (IOP). Remember one swallow doesn’t make a summer!

To diagnose glaucoma, all three tests viz. IOP, Perimetry (by a good standard perimeter), and Fundoscopy should be done.

Two consecutive positive tests on two separate occasions should clinch the diagnosis not otherwise. Patient should be given the benefit of doubt just as an LBW decision in cricket, unless, of course, if the glaucoma is laughing in the face saying that I am here.

Contrary to the earlier belief surgery doesn’t make a frontline treatment today in POAG, (with the present drugs available the scene couldn’t be rosier for a glaucoma patient).

Even in cases of closed-angle glaucoma, laser rabeculotomy or laser iridotomy should be the first line of treatment. Surgery should be the next line, in case laser doesn’t work.

Worldwide there are two best perimeters-HUMPHREY and OCTOPUS. Although there are a number of substitutes, these two are the gold standards.

Even in perimetry, a borderline field charting should not make one diagnose glaucoma, as this is a highly subjective test. Patient sitting at the other end is either too apprehensive or fails to grasp the test. Hence, it’s prudent to repeat the test at another sitting before labeling it as glaucoma.

Optic disc evaluation by a 90D lens is a must gives a stereoscopic view of the disc and catches the minutest details, which helps in making an accurate diagnosis.

Periodic evaluation every month to monitor IOP, every six months for perimetry, disc evaluation are imperative.

Though it’s true that 1 in 50 people above the age of 40 years suffer from glaucoma, the label of glaucoma should be give after a considerable thought only. Once given, the label remains for life, for no fault of the patient. One should not jump to this diagnosis unless it’s a clear case, because The damage caused to the Psyche is much more than the damage caused to the sight.

These guidelines help mainly in the borderline cases, that’s where a good judgment, wisdom and humanitarian approach is needed.